Innovative Approach to Unilateral Laminotomy for Bilateral Decompression: Overcoming Challenges with Minimal Resources in Iraq

Abstract

Background: Unilateral laminotomy for a bilateral decompression procedure for lumbar spinal stenosis has been increasingly accepted as an effective and safe alternative to conventional open decompression techniques. This approach aims to reduce postoperative instability by maintaining both facet joints, the neural arch, and the muscles of the contralateral side. 
Methods: Seventy patients were included in this study. All underwent unilateral laminotomy for bilateral decompression of the lumbar spinal canal through unilateral interlaminar fenestration without using advanced surgical equipment. Patient demographics and clinical characteristics were reviewed.
Results: The patients in the current study comprised 51 females and 19 males, with a mean age of 47.46 ± 10.52 years. Out of the total number of patients, 67.1% (n=47) had involvement in a single spinal level, 22.9% (n=16) had involvement in two levels, and 10% (n=7) had involvement in three levels.  An excellent outcome after surgery was 61.4%. Good and fair outcomes after surgery were observed in 27.1% and 8.6% of the patients, respectively. Only two patients (2.9%) showed no improvement after the surgery.
Conclusions: The lumbar 'over-the-top' unilateral laminotomy for bilateral decompression, performed without advanced surgical equipment, was feasible and associated with favorable clinical outcomes and substantial pain improvement.